COVID-19 Update by TD Chief Medical Director

Kim Parlee talks with Dr. VipanNikore, Chief Medical Director, TD Bank and CEO of Homecare Hub,about the readiness of economies to open up, and the country’s preparedness when the virus returns. Dr. Nikore also highlights the latest development in COVID-19 therapy and vaccine development.

- Hello, and welcome to the Money Talks COVID-19 Daily Bulletin for Friday, May 1. I'm Anthony Okolie. In a few minutes, Kim Parlee will be speaking with Dr. Vipan Nikore, Chief Medical Director of TD Bank and CEO of Homecare Hub about the readiness of economies to open up and the country's preparedness if the virus returns. But first, a quick wrap of today's headlines.

Tiff Macklem has been named the next governor of the Bank of Canada. He'll replace Stephen Poloz, whose term as governor ends on June 2. Macklem is the current dean of the Rotman School of Management and served as Senior Deputy governor for the bank from 2004 to 2007. Sales of Tim Hortons are struggling under the weight of the coronavirus. The company says it lost more than a third of its sales in recent weeks, as more people stay at home during the COVID-19 lockdown.

President Trump is warning he could use new tariffs on China over its handling of the coronavirus pandemic. Senior US officials have begun exploring proposals for punishing or demanding financial compensation from Beijing. Meanwhile, Amazon, which has benefited from surging e-commerce demand during the pandemic, missed estimates on first quarter earnings, but beat on revenue. And that's a wrap of today's headlines. Next, Kim Parlee's conversation with Dr. Vipan Nikore.

- As we're seeing more provinces and even more countries start to loosen up their stay at home policies trying to get things back to normal, I think the question a lot of people have is, is it safe to go back out in the world again?

- So it's a very good question. And reframe it a little bit, because the concept of going out into the world, it's not that it's not safe to go in the world right now. It's when many people go out and they aren't social distancing and they're bunched up together and the more people out in the world, it increases the chance of this virus spreading from a population perspective. So I just want to reframe the question a little bit there.

But is it appropriate for people to go out in the world, which is, I know, what you were getting at here. It's really regionally dependent. So it depends on multiple different factors in your region, such as the number of cases, the actual rate of decrease of daily cases per day, decreased rate of deaths, the contact tracing-- in particular, the testing in your region, which is critical to being able to control the virus. So it really depends.

When you look at New Brunswick in terms of what they have done, and, they've re-opened, they've had no deaths, they've had 11 straight days of decreased cases. They were on this early. And for them, it probably makes sense for them to open up. For New York City, probably not-- so very regionally dependent. One thing I would say is when you see people protest and they're all bunched up together and they're not social distancing, it actually decreases the confidence I have in that region being able to open up. Because it's demonstrating they don't understand the science around the disease, around the virus, and needing to be within six feet of each other to decrease the chance of transmission.

So if a community said, hey, I think we should open up. The number of deaths are going down at this rate, the number of cases are going down, and they were all socially distanced apart or had some thoughtful plan, I'd actually feel a little more convinced rather than a bunch of people, you know, putting up a sign and being bunched up together, if that makes sense.

- Yeah, it does make sense. And it's well said. Let me ask you, then-- so it is locally dependent, to your point. I mean, these are regional discussions that people have to figure out. But one thing I've been hearing a lot about is the second, third, fourth waves that, you know, I don't think it's if they're coming, but when they come. But when that gets mixed up with a regular flu season, what could happen?

- Yeah, it's a very good question. And you're absolutely right-- the virus hasn't changed, so we really should expect further waves. And it's an excellent point. Having been a medical director at a busy hospital, I can tell you during flu season is a very challenging time for most places, particularly here in Ontario, but really places all around the world. Handling those volumes-- you're doing surge lines, you're putting all these measures in place. People are often-- I can't say all hospital systems, but many hospital systems are at capacity during these times.

So if you're now adding not just a little bit of a blip but some spike from coronavirus, it is a little bit concerning. I think two lessons out of this-- one, people really have to get their flu shot this year to decrease the likelihood of getting the flu. And then hospital systems really have to be ready for the winter and prepare themselves.

- Let me ask you about vaccines. There has been some, I'll say, promising news with Remdesivir in terms of some of the work that's being done-- far from ready, far from those types of things, but we're seeing at least the market spike up on news that something could be happening. But maybe even bring us up to speed on what you're seeing from a vaccine standpoint-- how far out we are, and really what's entailed.

- For sure. So the first part, I'll talk about the Remdesivir, which is on the treatment standpoint. And for those of us who have been immersed in coronavirus since early January, we've actually been talking about Remdesivir early on. So for us, it's another positive signal. We've seen positive signals from Remdesivir since January to a smaller extent. It's nice that this is a 1,000-person trial that had to get stopped because of positive results.

The endpoint was the time that you have symptoms or the kind of infection, essentially. So you're going from 15 to 11 days based on this small set of data, which is obviously good. 15 days, when you think about it, is a long time to have-- if you think about the flu or anything, 15 days to have symptoms is a long time. So getting that down to 11, could it move the mark on hospital systems in terms of ones that are overwhelmed and help that? It could a little bit. It's hard to tell-- maybe ones that are really overwhelmed.

And one of the big things is going to be around mortality. There wasn't a statistically significant difference in mortality, even though there was a small decrease. But as numbers go up, that could very well change. This is a small trial. And the fact that we're seeing decreased time of symptoms does mean it's a positive signal. But there'll be more and more steps, and we've seen this a lot. There's hundreds of other trials and other things that could come out of the woodworks as well. So it's a positive signal. We're happy to hear that.

And the second part is the vaccine we were talking about. Various different candidates, probably over 60 different candidates out there right now-- I think most people have heard about the Oxford one that's been out there. That's about 6,000 people that are now in human trials-- again, these are positive signals. They're talking about having maybe a million vaccines by September, which is great. But if you think about it, we're still a long way-- again, positive signals, I'm hopeful, of course.

But most vaccines take years to develop. There was a study a little less than probably around seven, eight years ago talking about the average time to vaccine development is around 10 years, right? And some of the fastest ones like mumps has been four years. Ebola is around five years. So 1 to 1.5 years is an ambitious goal. I think we can do it. But it's important for people to understand that in the context, you take small groups of people, and then a larger group, and then a larger group, and then the manufacturing piece around distributing that to billions of people around the world is a challenge. But I'm hopeful. I think we can get there, but it's not going to be overnight. It's going to be a year.

- Yeah, valuable context. And I think people do need to understand the big picture. I have one last question for you. And from a question standpoint, this is going to sound broad, but I think it's important. What have we not talked about or what is not being talked about that should be talked around COVID-19? Because conversations tend to veer in one direction, what do you think is important right now?

- Yeah, I think when we think about opening up, we've talked about treatments, vaccine, the incredible importance of testing, contact tracing-- those are critical concepts. Two other pieces I'd say-- one is around how we do as a society-- how we open up is very much dependent on behavioral factors-- on when people go back to work, the systems and policies that are in place, how people behave.

If you open up and you have thousands of people together for various events, it's going to be hard to control the virus if that's the case-- if you have thousands of people at a concert or whatever it might be. And then the second part is really around how are we going to take care of our seniors and elderly and those with chronic disease. Having taken care of the actual COVID patients, we're still learning.

And one of the reasons social distancing and even staying at home, not only does it bring the disease down, but it gives us time to learn more from a scientific standpoint. And one of the most important things is how are we going to care for our seniors and those with chronic disease over the next year until we-- year-plus-- until we get a vaccine